SIGNIFICANCE OF SPECIFIC IMMUNOSSAYS IN DETECTION OF INSULIN ANALOGS IN FACTIOUS HYPOGLYCEMIA IN INVESTIGATION: 3 CASE REPORTS.

Dr. Samia A. Bokahri*, Dr. Sheefa Khan, Dr. Muneera AL Sharref, Dr. Rania Safwat, Amani Mohammed Gusti, Dr. Waleed Bawazeer

ABSTRACT

Objective: The aim is to highlight the importance of integrating specific insulin analog immune assays in the evaluation of hypoglycemic disorder investigations. Methods: We describe clinical, and laboratory findings of three study patients presented with spontaneous hypoglycemia and review the current relevant literature regarding methods of detecting suspicious factious use of insulin analogs by different insulin immunoassays to establish the cause of hypoglycemia. Results: The serum samples taken at the time of hypoglycemia in all three patients showed low insulin and low c-peptide. Mitigating and excluding other causes of hypoglycemia, factitious hypoglycemia due to insulin analogues was suspected. As usual commercial insulin assays don’t detect insulin analogues, Special immunoassays were performed to detect insulin analogues and high insulin levels in these assays confirmed factitious insulin analogue use. Conclusion: Clinicians should be aware of insulin analogues as potential cause of factious hypoglycemia and suitable insulin assays should be included in the algorhythm of investigations of hypoglycemia to detect the commonly used insulin analogues for proper diagnosis and management.

Keywords: Factitious hypoglycemia, insulin analogs, Immunoassay of insulin analogs.